Objective: To determine the frequency and stability of pain over time in a cohort of patients with early Parkinson’s disease (PD).

Background: Pain is a common non motor symptom in PD and reported in up to 85% of patients¹. Pain is ranked as one of the most troublesome non motor symptoms². Whilst there are a number of cross-sectional studies, the frequency and stability of pain over time has not been extensively studied. There is a paucity of high quality studies investigating pain management in PD³. To develop interventions, understanding of how pain changes over the disease course is required.

Method: 154 participants with early PD and 99 age-and gender-matched controls were recruited as part of the Incidence of Cognitive Impairment in Cohorts with Longitudinal Evaluation in PD (ICICLE-PD). Pain data was collected at 18-month intervals over 72 months using the Nonmotor Symptom Questionnaire (NMS-Q), consisting of a yes/no response for both groups. Questions from the Parkinson’s Disease Questionnaire (PDQ-39), ‘had painful muscle cramps or spasms?’ and ‘had aches and pains in your joints or body?’ were analysed for the PD group. Comparison of the NMS-Q for the PD and control group over time was assessed using the X² test. Pain over time for the NMS-Q in the PD group was assessed with Cochran’s Q, and post hoc McNemar test. Stability of pain over time was calculated descriptively.

Results: The PD group reported significantly more unexplained pain than the control group at each time point except at 36 months (baseline X²=39.5 p=<.001, 18 mo X²=54.4, p=<.001, 36 mo X²=3.6, p=.057, 54 mo X²=7.7 p=.06, 72 mo X²=17.6, p=<.001). Cochran’s Q test did not show any difference at the time points (X²= 8.28, p=0.82) for the PD group. Unexplained pain fluctuated over time, 2% had consistent pain, 9% had no pain and the remaining 38% fluctuated between yes and no. The PDQ39 questions demonstrated fluctuation with 2% of individuals not reporting muscle spasms and cramps. Every PD participant reported experiencing aches and pains a time point.

Conclusion: Pain is frequently reported in early PD, in particular aches and pains. Pain changes over time in PD, with fluctuations being common. Aches and pain frequency reduces over time, whilst reports of muscle cramps and spasm increases. Pain in PD is problematic; however, the frequency of the type of pain differs as the disease progresses. Further research is required into the type of pain in Parkinson’s disease over time.

References: 1. Silverdale, M.A., Kobylecki, C., Kass-Iliyya, L., Martinez-Martin, P., Lawton, M., Cotterill, S., Chaudhuri, K.R., Morris, H., Baig, F., Williams, N. and Hubbard, L.(2018). A detailed clinical study of pain in 1957 participants with early/moderate Parkinson’s disease. Parkinsonism & related disorders, 56, pp.27-32. 2. Politis M, Wu K, Molloy S, Bain PG, Chaundhuri KR, & Piccini P. (2010) Parkinson’s Disease Symptoms: The Patient’s Perspective. Mov Disord. 25(11) pp. 1646-1651 3. Qureshi, A.R., Rana, A.Q., Malik, S.H., Rizvi, S.F.H., Akhter, S., Vannabouathong, C., Sarfraz, Z. and Rana, R. (2018). Comprehensive examination of therapies for pain in Parkinson’s Disease: a systematic review and meta-analysis. Neuroepidemiology, 51(3-4), pp.190-206

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MDS Abstracts - https://www.mdsabstracts.org/abstract/trajectories-of-pain-in-newly-diagnosed-parkinsons-disease/